Swelling (edema) of the limbs: what causes swelling of the hands, feet, ankles?

Swelling of the limbs can occur in a variety of conditions, from musculoskeletal problems to diseases of the vascular system or heart to diseases of the lymphatic system.

Sometimes the swelling is local and occurs only in one place, sometimes it is generalized and is in several places of the body. If swelling occurs around the ankles, very often it is a problem with the heart.

This is the case if the swelling occurs in both limbs. When swelling occurs in one limb, a blockage or inflammation of the blood vessels is suspected, for example, as in venous thrombosis.

Swelling of one limb

Swelling occurs in one limb, either lower or upper, as a result of local inflammation or an injury. In most cases, it is a disease of the veins of the lower limbs. Swelling, pain and muscle fatigue occur.

They also arise in varicose veins, which is the most common vein disease. Sometimes the cause is in the blockage and inflammation of the vein. These diseases also include thrombophlebitis or phlebothrombosis.

Thrombophlebitis is an inflammation of the superficial veins. The thrombus presses on the inflamed vein wall. There is local swelling, redness and pain at the site of the inflamed vein. It is harder to the touch. The disease is not serious.

Phlebothrombosis is an inflammation of the deep veins and is a serious disease. Its complication can be embolization to the lungs. But also later changes such as varicose veins or tibial ulcer.

Chronic venous insufficiency is a disease in which the return of blood from the lower limbs is reduced. As a consequence, there is a build-up of blood and also swelling of the limb or both.

Symptoms of chronic venous insufficiency:

• Feeling of heavy legs
• leg fatigue
• tension to cramps
• muscle pain
• swelling
• impaired tissue nourishment
• changes in skin colour, pigmented
• poor wound healing
• tibial ulcer

Swelling of one limb also occurs when lymph outflow is blocked. Lymphedema is a disease that is caused by the accumulation of lymph in the tissues as a result of poor lymphatic system function.

Lymphoedema also arises after operations in which local lymph nodes have had to be removed, such as cancer surgery.

Even cancer itself can be a cause. And it can be directly on the bone, whether it is a benign or malignant tumour. Here, swelling develops at the site of the tumour. It arises from bone cells or bone cartilage. It can also occur in other cancers.

Injury is a common cause of swelling of the limbs. Swelling occurs at the site of excessive force. The damage can involve the skin when the wound is only superficial, but also deeper structures. And it can be tendons, blood vessels or muscles.

Swelling also occurs naturally with bone fractures. In addition to swelling, pain is present with injuries, as well as redness and, if the skin integrity is broken, external bleeding. The type of treatment and specialist assistance is assessed according to the mechanism of injury, extent and type of injury.

Similarly, joint disorders may include arthritis of minor or major joints and other injuries. Symptoms include pain and redness in the area of the affected joint.

Swelling of the limb is a common complication after surgery. The reason for surgery may be the aforementioned joint disease, an accident, a complicated bone fracture, as well as other medical causes.

Swelling of both upper limbs

Swelling of both upper limbs at the same time may indicate a more complex disease. It occurs, for example, in the case of superior vena cava syndrome. This vein collects blood from both limbs, head and neck.

In severe diseases of the heart, liver or kidneys, swelling of the whole body may occur. As in the failure of the heart to function as a pump, but also in swellings due to a non-functioning liver or in renal insufficiency.

Initially, swellings arise in the lower parts of the body due to gravity, i.e. the lower limbs. But if the difficulty persists, the swelling spreads to the whole body.

Swelling of both lower limbs

Swelling of both lower limbs is a common symptom of heart disease, specifically chronic heart failure. Heart failure is characterized by the heart's inability to produce enough power to meet the body's needs.

This occurs mainly with increased exertion. Increased exertion may mean running, walking up stairs, but also walking on flat ground. In more severe cases, even walking short distances.

The blood is not pumped sufficiently, fluids are retained in the lowest parts of the body. Swelling of the legs is the first symptom, but also swelling of the limbs in the ankle area.

In later stages, the swelling increases and the shins or other parts of the body swell. In heart failure, swelling of both upper limbs may also occur. Reduced heart function and swelling of the lower limbs and legs are common in old age.

The most common causes of heart failure include:

• Ischaemic heart disease
• heart muscle infarction
• cardiomyopathy
• untreated and prolonged high blood pressure
• valve defects
• heart rhythm disorders
• congenital and acquired heart defects

In problems with high blood pressure, changes in the arteries also occur and the left ventricle of the heart is enlarged. Frequent headaches, fatigue and swelling of the limbs due to impaired heart function are typical.

Similarly, in myocarditis, which is an inflammation of the heart muscle that can become inflamed, most often by viruses. Symptoms of the disease are mainly chest pain and shortness of breath. Sometimes there is swelling not only locally, but also throughout the body.

Swelling of both lower limbs is also a symptom for diseases of other organs of the body. This is the case in the case of liver and kidney failure. For example, in liver failure, in addition to swelling of the limbs, there is also significant swelling of the abdomen (ascites) and icterus (yellow discoloration of the skin and whites of the eyes).

In more severe kidney disease, renal insufficiency, i.e. kidney failure, may occur. It may be acute or chronic. Swelling of the limbs and face, as well as nausea, vomiting, increased or decreased urine production or even cessation of urination, fatigue, lack of appetite, weight loss, dry skin are present.

Other causes of swelling of the limbs

Swelling of the limbs can also occur with chronic bronchitis. They occur as a complication, specifically with the onset of chronic obstructive pulmonary disease. But they also accompany other lung diseases.

Very often, swelling of the extremities is also present as part of other secondary problems. For example, in obesity, which is caused by increased weight. Also in the case of certain metabolic diseases, such as Cushing's syndrome.

Swelling of the hands and feet are also part of the symptoms of Turner syndrome. This is an inherited disease caused by the absence of the X chromosome and affects women who have only one sex chromosome.

Even reduced dietary intake (starvation, eating disorders, anorexia) are causes of swelling of the limbs. This is due to a lack of protein. Reduced albumin levels in the blood cause fluid from the blood to permeate the tissues and cavities. Abdominal swelling is typical in starving children.

Thyroid disease, specifically hypothyroidism, can result in swelling. Certain medications cause swelling of the extremities. Examples of these medications are hormonal contraceptives, but also painkillers, corticosteroids, and antidepressants.

Prolonged sitting and standing in one position can result in swelling of the lower limbs. This is especially the case when sitting in an uncomfortable position. It also happens, for example, during long journeys in cars, buses and even during flights (so-called traveller's thrombosis).

Travelling, especially flights longer than 6 hours, are a risk for embolisms. This mainly affects people who have a predisposition or risk diseases. These include, for example, increased blood clotting, varicose veins, heart or kidney disease, obesity, but also the use of hormonal contraceptives.

A common, but not serious, cause of swelling of the limbs is an allergic reaction. Swelling can be local, i.e. at the point of contact with the allergen, as in the case of a wasp or bee sting, or more extensive, as in food or drug allergies.

An allergic reaction is actually an exaggerated reaction to an allergen. More information about allergies is given in a separate article.

Swelling of the limbs in pregnancy

During pregnancy, swelling of the legs and ankles occurs in up to 75% of pregnant women, especially during the last few weeks of the third trimester. The enlarged fetus and uterus then reduce blood flow through the inferior vena cava back to the heart.

But swelling occurs much earlier. The main reason is fluid retention in the body, an increase in the total volume of fluid in the body. This is harmless and normal swelling.

On the contrary, swelling of the limbs in pre-eclampsia is dangerous. Pre-eclampsia is pregnancy-induced hypertension (high blood pressure). Protein in the urine and swelling of the limbs are present.

Tip: We talk more about pre-eclampsia and how to recognize it in the magazine article.